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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Risk Assessment of Cognitive Impairment at 2 Years of Age in Infants Born Extremely Preterm Using the

Ariel A Salas1, Waldemar A Carlo1, Carla M Bann2

  • 1Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.

The Journal of Pediatrics
|August 21, 2024
PubMed

Insights

Monitoring infant growth using INTERGROWTH-21st standards can identify extremely preterm infants at risk for cognitive impairment. Length and head circumference z-scores are key indicators for early intervention.

Area of Science:

  • Neonatalogy
  • Developmental Pediatrics
  • Pediatric Neurology

Background:

  • Extremely preterm infants face heightened risks for neurodevelopmental challenges.
  • The INTERGROWTH-21st standards provide a framework for assessing fetal and newborn growth.
  • Early identification of cognitive impairment risk is crucial for timely intervention.

Purpose of the Study:

  • To evaluate the utility of INTERGROWTH-21st standards in predicting cognitive impairment in extremely preterm infants.
  • To identify specific anthropometric markers and growth patterns associated with cognitive deficits at two years of age.
  • To refine definitions of growth failure and faltering for improved risk assessment.

Main Methods:

  • Analysis of anthropometric data (birth and 36 weeks postmenstrual age) from 5393 extremely preterm infants (24-26 weeks gestation).
  • Utilized classification and regression trees to determine INTERGROWTH-21st z-score thresholds for cognitive impairment risk (Bayley cognitive score <85).
  • Redefined growth failure (z-scores at 36 weeks PMA) and growth faltering (z-score declines from birth to 36 weeks PMA).

Main Results:

  • Growth failure (weight z-score ≤ -1.8 at 36 weeks PMA) and growth faltering (weight z-score decline ≥ 1.1) were linked to higher cognitive impairment likelihood.
  • Length z-score < -1 at 36 weeks PMA demonstrated the highest sensitivity (80%) for detecting cognitive impairment.
  • Head circumference z-score decline ≥ 2.43 showed the highest specificity (86%) in risk detection.

Conclusions:

  • Length and head circumference z-scores are sensitive and specific indicators for predicting cognitive impairment in extremely preterm infants.
  • Monitoring these growth parameters can facilitate earlier, individualized interventions.
  • Optimized growth monitoring may help mitigate the risk of cognitive impairment in this vulnerable population.
Abstract

Keywords:
anthropometric measurementsneurodevelopmental impairmentprediction modelpremature newborns

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